Cross-Cultural Counseling

Contents

Introduction

Studying cross-cultural mores and values helps counselors develop an openness to cultural variability and the relativity of ones own values. If the counselor makes an ongoing attempt to bridge the differences between his culture and the culture of the client, then the counselor creates a framework of understanding that helps to establish the basic elements of trust. If the client does not feel his cultural background is understood and appreciated, it is possible he may not stay in therapy long enough to discover the benefits. Compared to white clients, Black, Hispanic, American Indian, and Asian clients are 60 percent more likely to terminate counseling after one session. This may be caused in part by the counselor’s lack of knowledge of cross cultural mores and values.

The field of cross cultural counseling is a relatively new one. It was not until the Civil Rights Movement in the 1960s that the counseling field began to address the problems and issues arising from different cultural backgrounds and value systems between client and therapist. It has only been within the last 15 years that the knowledge of the culture of one’s client has been raised as an ethical issue. However, knowledge of the culture of the client should not imply a stereotype, nor should therapy be the same for all members of one cultural group. The values of a cultural group may vary greatly according to education, socio-economic level, and length of time in the United States. Basic information about the client’s culture does, however, provide the therapist with a working basis of knowledge to be unified, discarded, or modified based on additional information acquired during the course of therapy.

This paper explores the history, values, and mores of Blacks, Hispanics, Asian Americans, and American Indians for the purpose of becoming a more effective counselor for people of non-white backgrounds.

Asian Americans

History

The Chinese were the first Asian group to arrive in the United States in large numbers. In the 1800s the Chinese were a large part of the labor force on the West coast. As recession occurred and work became scarce, the Chinese became the focus of racism and harassment. The early Japanese history also reflects discrimination, most blatantly evident in the World War II incarceration of 110,000 Japanese Americans in concentration camps.

Current status

A contemporary image of Asian Americans, particularly Japanese and Chinese, is that of a highly successful minority who has “made it” in American society. The 1970 census seems to support the contention of the “model minority” that Asians in this country have exceeded the national median income. Asian Americans students complete a higher number of grades than all other groups. The high incidence of interracial marriages for Japanese Americans also seems to indicate a lack of social distance between Japanese and whites.

A closer analysis of the status of Asian Americans according to Sue (1981) does not completely support this image. Asian Americans brought many ancient customs and traditions with them to the United States, many of which still impact the Asian American today. The Asian Americans are not an inherently “healthy” group that should be overlooked by the mental health services.

Family structure and roles

Traditionally, marriage does not mark the creation of a new family, but rather the continuation of the man’s family line. The wife is considered to have left her family of origin and becomes absorbed into her husband’s family. The role of the Asian woman is to follow the lead of the men in her life — first her father, next her husband, and then in later years, her oldest son.

Within the nuclear family, the father is the leader. He makes the decisions and his authority is unquestioned. Within the eyes of the community, the successes or failures of the family and its individual members begin with the influence of the father. The father is the primary economic provider and the major disciplinarian. He is sometimes seen as somewhat stern, distant, and less approachable than the mother. The traditional role of the mother is the nurturing caretaker of both husband and children. The strongest emotional attachments tend to be with her.

Traditionally, sons are more valued than daughters. Females are raised for the families of others, while sons are raised to marry and bring women into the family. The oldest son is the most important child. He is the role model for his siblings and many times has authority over them. The pressures and expectations of this role can cause conflict within him and within the family as a whole.

Cultural issues

Obligation and shame greatly influence the Asian American. Highly developed feelings of obligation govern much of the traditional life of the Asian people. Shame and loss of face are frequently used to reinforce adherence to obligations. The greatest obligation of Asians is to their parents.

In contrast to Anglo society, the Asian culture focuses on the concept that individuals become who they are through the effects of many things and many people. Individuals are seen as products of their relationship to nature and people. There is an emphasis on maintaining harmony through proper conduct and attitudes.

The welfare and integrity of the family is of great importance. Members of the family are expected to put welfare of the family above their own feelings. Thus, the behavior of the individual is expected to reflect credit on the entire family. If a member of a family behaves in a way that embarrasses or shames himself, the entire family is shamed. The stress on reputation and saving face is so strong that problems are handled as much as possible within the family.

Therapy

Though the Japanese, like other Asian Americans, may have personal and family issues that could lend themselves to counseling, the therapist needs to respect the idea that the process of entering treatment is not an easy one for Asian Americans. Many wait until there is severe disturbance before seeking help. The three major reasons, according to Shen (1982) are: 1) lack of familiarity with Western mental health concepts, 2) their problem solving approach that is internally oriented, and 3) social stigmatization attached with being “crazy.” Asians believe that “craziness” is caused by a hereditary trait, punishment for past behavior of the family, or poor guidance or discipline by the family leader. Because these are all issues that reflect shame on the family, Asians frequently enter treatment as a last resort, feeling ashamed and defeated.

The Asian family, especially the parents, see the therapist as a knowledge expert who will guide their family in a proper course of action. The family expects the authority figure to be more active than passive. Showing proper respect for the roles in the family (for example, reinforcing the father’s role) is essential in building an alliance.

The therapist must be sensitive to the fact that the therapeutic relationship necessarily incorporates many aspects of communication with which Asians feel uncomfortable. The individual’s age, sex, education, social status, and family background define whom he may talk to and what he may say. Knowledge about personal attributes generally causes anxiety. Harmony in personal relationships is valued above direct confrontation. Therefore, a behavioral approach that respects the family structure will be most effective.

Blacks

History

Although Blacks have come to the United States from different countries, the largest number are those whose ancestors were brought here from Africa as slaves. The history of the majority of Black Americans is thus one of degradation and destruction. Their survival of these experiences is the bond that holds them together and sets them apart from other Americans.

Current status

Color remains a predominant distinguishing fact of life for all Black Americans. Though a growing proportion of the black population is becoming upwardly mobile, the majority of Blacks remain far behind whites in almost every social, political, and economic area, a legacy of the effects of poverty and oppression.

Family structure and roles

Roles in Black families developed from the interplay of African heritage, acculturation, and attempts to cope with the stress of oppression. The role of the Black male is one that has been characterized by majority culture as “peripheral.” According to Hill (1972) the issue of peripheralness has been mostly overstated. He claims that although the role of black males as fathers and mates does vary, particularly along socio-economic lines, the Black father, regardless of income, is likely to demand and receive recognition as the head of household with both wife and children (Tenhouten, 1970).

The fact that the identity of the Black male is tied to his ability to provide for his family does present a conflict for the Black husband and father who has difficulty securing and maintaining employment that provides even the basic survival needs of his family. Black women have historically worked outside the home, and have often been the sole wage earners in times of high unemployment. Most Black males and females grow up with the idea that both will work and share household responsibilities. Black women have consistently been a strong assistance to their husbands and families, but Hines (1982) states that this does not lead to the conclusion that Blacks have a matriarchal family system.

Strong bonds of kinship among Black families can be traced to historical origins in Africa. Though slavery was a major disruption to close kinship and family ties, Blacks continue to place high value on family life. The extended family kinship system, not necessarily drawn from “blood lines,” remains a major mode of coping in the Black community (Foster, 1971). The Black culture emphasizes service to both the family and the community.

Cultural issues

In many black families there is a strong emphasis on education: parents want their children to “have more than they had.” Despite this emphasis, however, few lower socio-economic parents have the knowledge or skills needed to assist their children’s education careers.

Traditionally, Blacks have looked to resources other than therapy when solving problems. The church, for example, has been instrumental in providing Blacks with a sense of leadership, positive self-esteem, and active social life. Thus, Blacks turn to the church with their thoughts and feelings, or when attempting to deal with psychological stress. Many personal problems are also worked out within the family system. Here the mother assumes a prominent role, for she is viewed as being warm and accepting. Finally, the Black experience with mental health services in the past has been a negative one. Prior to 1965, Black experience in mental health was limited to emergency care and state mental institutions (Pedersen, 1981).

Therapy

The Anglo therapist dealing with Black families must be willing to deal with issues openly and honestly to build trust in the therapeutic relationship, and therefore help the family create change. When beginning therapy, the therapist needs to be aware that trust may not be easily gained in the therapeutic setting. The therapist can help build trust by explaining the therapeutic process. In the past, Blacks have viewed therapy as reserved for “crazy people” rather than assistance for creating positive change. The therapist also needs to explore the family’s feelings regarding seeking help and acknowledge and discuss feelings surrounding ethnic differences, rather than attempting to appear “color blind.”

The most frequent issues that bring Black families to treatment are poor school adjustment, acting out behavior, depression, psychoses, drug addiction, and alcoholism. The difference between upper and lower class Black families is the range and severity of the problem. The Identified Patient is usually a child. Black families are likely to respond best to time-limited problem solving and child-focussed family therapy approaches. The therapist needs to help the family experience therapy as a process that can help produce immediate change in their lives. Because Black families are enmeshed in a complex kinship network, it may be appropriate to include extended family members in the therapeutic process. At times it may be difficult for the Black father to come to therapy on an ongoing basis. The therapist may need to find another way to maintain contact with the father in order to communicate respect for the father’s position and decrease the potential that he will sabotage therapy.

The therapist dealing with poor inner-city Black families will have to be willing to consider a broadened treatment approach that includes an assessment of the family’s environment and community resources. Their daily reality may include welfare, the courts, the school system, food stamps, public housing, etc. The effective therapist will need to know the social service system and be willing to help make contacts with various service providers when necessary. The therapist may have to help the clients learn how to survive before focussing on family conflicts.

Issues of “resistance” from a Black family need to be dealt with from a cultural perspective. Avoidance of eye contact can be a cultural communication style. The failure of the Black client to deal openly with feelings can be more cultural paranoia than resistance to therapy (Hines, 1982). Black clients often downplay the importance of childhood experiences in terms of their current mental health. The “resistance” of the low-income black family in arriving at sessions on time can be well grounded in parenting, transportation, or employment issues.

American Indians

History

Before the Europeans came to America, the Indians lived in relative peace both among themselves and with the land. This was not to last, however, as the immigrants began the great push westward. The settlers used lies, trickery, and force in sweeping the Indians from their lands. Although it started shortly after Columbus discovered the new world in 1492, Indians were still dying in America when Mercedes Benz in Europe introduced the first automobile in 1886.

Current status

Indians now find themselves to be second-class citizens. Between extremely low average income and high rates of alcoholism, Indians fight the same battle for survival and self-esteem they have for the last 100 years. Until just eleven years ago, even their destiny was shaped by others, in the form of the non-Indian run Bureau of Indian Affairs.

Family structure and roles

The traditional pattern of family organization involves three generations, with many parental functions delegated to aunts, uncles, and grandparents. Grandparents maintain a close tie with their grandchildren and are actively involved with infant and toddler care. Aunts and uncles have disciplinary responsibilities with children, freeing the parents to enjoy the more pleasurable experiences with their children. The extended family ties provide a sense of security, affection, standards of behavior, and a variety of role models. Sex roles are quite specific. The responsibility for teaching self-discipline and appropriate skills falls to the same-sex parental figure.

As economic patterns affected changes in the Indian family, many families disintegrated into female-headed households. Often in urban communities, these households also lacked the support of the extended family. According to Attneaue (1982) the breakdown of the Indian family structure has caused great difficulties for the Indian woman regarding parenting her children, particularly the male children. Parent education and support groups have become vital for Indian families. With unemployment rates of 70 to 80 percent on many reservations, the future development of a positive male role model seems a remote possibility.

Cultural issues

The values of the American Indian are in many ways in direct conflict with the Anglo values. Indians who choose to follow the old traditions are virtually unable to survive, while those who choose to adopt Anglo ways must give up almost all of their proud heritage.

Though there is great diversity of culture and values among Indian tribes, there are some basic values that reflect the American Indian approach to life (Bryde, 1972). Indians are present oriented, and don’t feel that they are pressured by time. They are also generous and sharing, believing that he who gives most commands the most respect. Indians also respect the aged as holders of wisdom and knowledge. Finally, Indians cooperate with each other, emphasizing harmony instead of control. This extended to their relationship with nature.

Because of these and other differences, the American Indian must make major adjustments in cultural thinking in order to assume the values of the Anglo society.

Therapy

Counseling from a “textbook” approach emphasizing Western values will not be effective with the American Indian. The therapist must first show respect for Indian values.

Indians appreciate a natural and casual style. A calm delivery with comfortable silences is appropriate. The therapist should be honest and direct, and get right to the point of why the client was sent to you. Focus on problem-solving with joint goal setting and establish a time for termination of counseling. This will help reduce the suspicion that the therapist is just another bureaucrat. You can then go back later and fill in the details.

An eclectic approach incorporating both directive and non-directive techniques seems to work best with many Indian families. Directive techniques such as synthesis, diagnosis, and follow-up should be utilized while avoiding giving advice, time structuring, or striving for control in the sessions.

From a non-directive perspective, it is appropriate to show faith in the individual or family’s capabilities and to allow individuals to take a more active part in finding solutions to their own problems. The therapist should avoid a completely non-directive attitude because the Indian may view this as a waste of time. The Indian expects direction and wants to know where you stand.

Finally, as with Asian clients, the therapist must be aware that each generation has different problems, and must be approached differently in therapy.

Hispanics

History

Until the settlers pushed westward to the Pacific, many Mexicans lived in what is now the American southwest. Many of these indigenous people were displaced as these territories fought for and achieved statehood. The Hispanic population began to grow rapidly in the early 1900s when thousands of Mexicans fled the violence of the Mexican Revolution. Because of the unemployment of the Great Depression of 1910, however, many of these immigrants were deported or pressured by the U.S. government to return to Mexico. During World War II, a new wave of Mexicans immigrated to the United States. Many were “braceros,” farm workers who were issued temporary work permits.

Current status

The geographical proximity of Mexico and the United States has resulted in a continuing interaction between these two countries. For example, many Mexicans continue to enter the United States daily in search of better economic opportunities. Since the 1960s, however, the majority of Mexican immigrants are no longer granted U.S. legal alien status. Fear of detection and deportation by “la migra” (immigration authorities) permeates the lives of the aliens. Understandably, they avoid medical and psychological treatment.

According to Falicore (1982) the challenges facing today’s Hispanic include discrimination in housing and education, low paying, low prestige jobs, exploitation by employers, a high unemployment and school drop-out rate, and the inability or unwillingness to accept welfare or other financial support.

Family structure and roles

The majority of Hispanic couples remain married for life. The parental functions of the Hispanic parent are complementary: the Hispanic father disciplines and controls while the mother nurtures and supports. Both engender the respect of children. This implies an emotional dependence and dutifulness within a fairly authoritarian framework.

During the earlier years, the father is often permissive, warm, and close to the children. As each child reaches puberty, the father’s behavior becomes much more reserved, authoritarian, and demanding of respect. In contrast, the mother continues to be close and warm even when her children are grown, married, and have children of their own.

Beyond the nuclear family, Hispanics have close ties with the extended family (grandparents, aunts, uncles, and cousins). Another extended family kinship that is prevalent in the Hispanic family is “compadrazo” (compadre and comadre). Compadre and comadre are titles of formal kinship and are granted to close friends of the family.

The identity of the male and female Hispanic is closely connected with the family structure. Differences in patterns of behavior are taught implicitly from an early age. Boys are taught how to think like a man and girls are taught the feminine role. Boys are discouraged from sharing weaknesses or appearing unmanly. They strive to be self-controlled, and expect females to attend to their physical needs. Girls are taught to deny their needs in caring for the needs of others, to be submissive, and to look to the male for protection.

Cultural issues

Martinez (1978) describes the differences of culture between the Hispanics and the Anglos as differences in mental set or orientations, style, or “naturalness” in behavior. For example, the Hispanic is likely to view material objects as necessary things, not ends in themselves. Work is viewed as necessary for survival but not as a value in itself. To the Hispanic, it is much more valuable to experience things through intellectual awareness and through emotional experiences rather than indirectly through past accomplishments and the accumulation of wealth. Social status and prestige are more likely to come to a person who exhibits this type of “spirituality” and shares such knowledge and feelings with others. The philosopher, poet, musician, and artist are often revered more than the businessman or financier.

The Hispanic is also more likely to live and experience life in the present. One effect of this time value is worth noting: In the Anglo culture, being responsible is equated with being on time. The Hispanic feels a different sense of priorities, however, and may for example consider attending to the needs of his family and friends more responsible than being on time.

The traditional Latin communication style requires diplomacy and tact. Concern and respect for the other’s feelings dictate that a screen always be provided behind which a man may preserve his dignity. The Hispanic’s manner of expression is likely to be elaborate and indirect, because he also takes pride in the art of verbal expression. Thus the Hispanic often finds himself in difficulty if he disagrees with an Anglo’s point of view. To him, direct argument or contradiction appears rude and disrespectful.

Therapy

The Hispanic family mores dictate that the Hispanic seek out the advice of the family before soliciting help from the professional. If a Hispanic seeks mental health services before consulting his family, he may experience cultural conflict as well as resistance to therapy because the Hispanic culture reflects strong family ties not only with the immediate family but with the extended family as well. What may appear to the therapist as overdependency on the family may be normal behavior in the context of the Hispanic culture. The struggle for identity, therefore, may cause cultural and familial conflicts as well as internal strife.

Because sex roles in the Hispanic culture are more clearly delineated, presenting problems such as a man losing his job or a woman gaining employment may have more serious cultural implications than in Anglo families.

In dealing with the Hispanic wife, it may also be helpful to seek approval of the husband. The husband’s resistance toward therapy can influence his wife’s attendance. One way for the therapist to deal with this resistance is to first emphasize the medical aspects of the problem, because Hispanics are much more open to seeking medical assistance than psychological help. The therapist should also give the Hispanic client a clear description of the therapy to help relieve some of his anxiety about the unknown.

In initial sessions, Hispanics are more formal, polite, and reserved. The therapist should take into account that an informal approach may be confusing and inappropriate. Direct questions and expectations af full disclosure may increase suspiciousness and bring up defenses. The therapist should initially address his question to the father, the mother, and then siblings, in order to demonstrate respect for the family structure. One further way the therapist can show respect for the family structure is by starting therapy examining the parent-child relationship. Marital issues and issues dealing with the family of origin should be postponed until after the therapist has established a rapport with the family.

During the exploration of the family’s immigration pattern, the therapist must be sensitive to the fact that families may not fill in all the details due to issues surrounding illegal entry into the country. The proximity and involvement of extended family members should also be explored to determine if extended family members should be involved in therapy. The therapist may have to encourage the family to express their reactions to his comments, because disagreement with an authority figure is seen as impolite.

Hispanic families of lower socio-economic levels appear to respond best to brief problem-oriented therapy that redefines the problem in interactional terms centered on the parent-child relationship. The cultural emphasis on hierarchies within the family lends itself to a structural approach to family therapy. Within a problem-oriented framework, an emotive approach is usually more appealing to the Hispanic, rather than an efficient, highly structured behavior modification approach. Hispanics respond more openly when feelings are subtly elicited. Positive reframing and paradoxical interactions can also be useful.

The therapist who deals most effectively with the Hispanic may also have to be involved in an outreach program in the community, which may mean becoming involved in community activities and visiting clients in their homes. Much of the therapy for Hispanics involves some form of education or advice, therefore it is essential that the therapist know something about the services in the community in which he works. The community mental health center with bilingual counselors may be the ideal setting.

Summary

Cultural differences enrich our lives. Unfortunately, they may also serve as impediments to effective cross cultural counseling as racism, discrimination, and bigotry are other by-products of these differences. More subtly, the therapist can unconsciously substitute his own cultural preferences and ideals of normality and appropriateness in analyzing the actions and behavior of the client.

In cross cultural counseling we must respect and understand cultural differences in order to create effective therapeutic relationships. This includes dealing with language differences and the effects of discrimination, which we must acknowledge and work through.

As therapists’ client bases broaden to include individuals from many different races and cultural groups, therapists must endeavor to cross the boundaries of their own cultural backgrounds and become versed with the mores and values of other groups in order to effectively deal with their clients. It is up to the mental health professional to lower the barriers that deny access to therapy for those of other cultures.

Professional Insights

In my work with clients from other cultures, I find that I have little difficulty with stereotyping, resistance, transference, and client expectations. This is not to say that these issues never come up. However, because of my training, I am able to prevent them from negatively influencing counseling.

On the other hand, I find that I am far more impacted by counter-transference, goal setting, and communications styles. Given the cultural cross-section of the majority of my clients, this wouldn’t seem to be much of a problem. But like many other counselors, I find that as time goes on more and more of my clients are from a different cultural background than I am.

Counter-transference is something I am confronted with on many levels when doing cross cultural counseling. One example would be when I see a woman in what I consider to be a demeaning role, I must always remember that what I consider demeaning may be workable and acceptable to a family from another culture. Another situation that triggers my counter-transference is working with families in which the female children are taught to be dependent on the male for their lives and happiness. In this area, I must remember that this dynamic is culturally determined and therefore, unless I see a serious problem in the area of the child’s dependency needs, I must respect the right of the family to raise their child as they feel is appropriate. Finally, I also have the tendency to feel some irritation towards families in which the male children are accorded greater status than the female children. I realize, however, that these are my counter-transference issues and not the problems of the family. I need to show respect for their culture and heritage, unless, for example, the families actions serve to make a child a scapegoat, and there is the potential for abuse. Then, the status issue must be confronted no matter what the cultural issues are.

Goal setting in cross cultural therapy emphasizes dealing with the daily problems of living, versus traditional therapy that stresses the role of childhood experiences in the development of personality and behavior. Often, families from other cultures need to be able to attain a goal in therapy in order to feel a sense of accomplishment that makes the time and effort spent in counseling seem worthwhile. This is a different way of conducting counseling than I am used to, and it is sometimes difficult for me to help the family focus on day-to-day matters when I can see that there are much larger intrapsychic issues looming in the background. I have found with Blacks, however, that I am sometimes able to tackle some of the larger issues while taking care of the day-to-day matters.

One of my biggest challenges lies in dealing with feelings as is culturally appropriate for the family I am counseling. Because of my training, my natural inclination is to start talking about feelings as soon as practical in counseling. Again, Blacks seem to be most comfortable with this approach, but Asians find this very uncomfortable. Not only are Asian parents unwilling to explore their feelings, but they give a clear signal that they don’t want their children doing so either. By encouraging children to express themselves, I could not only make the parents in some cultures feel that they had not been respected, I might even bring shame onto their entire family. I have worked very hard at meeting the family on the level at which they are accustomed.

One last issue that I sometimes have to deal with is that of being a female therapist. This most often arises when counseling Hispanics, for example, because of their position concerning the role of women in their society. In the cases I have handled, however, I have found that although the Hispanic father might resent having a female in a position of authority, this does not create a severe difficulty in the therapeutic relationship, because I have shown respect for the father’s authority and have not overly aligned with the mother or children in the course of counseling.

The Black male appears to have less trouble in relating to a female because of his socio-cultural background of accepting women in different terms than the Hispanic male. I have also found in counseling with Black families that there can be a conflict with the father without seriously injuring the therapeutic relationship. This is probably due to the normally higher level of give and take between the father and mother in the Black family.

One benefit of my nurturing background is that I find I more easily establish a rapport with women of other cultural backgrounds. This has given me more time to focus on establishing rapport with the male, which is very important in cultures that feature a dominant male.

As I was writing this paper, I came to realize that, in spite of the paper’s length, for every point I listed there seemed to be three points I had to leave out. This stood in stark contrast to discussions of this subject with my peers, who, being mostly middle-class and white, hadn’t taken the time to learn about cross-cultural differences. Therefore, they were not a good source in learning about cross cultural issues. Since writing this paper, I now have developed some good resources for researching the cultural differences I can expect to find in new non-white clients before beginning therapy with them.

References

Attneaue, C. “American Indians and Alaska Native Families: Emigrants in Their Own Homeland.” In Ethnicity and Family Therapy. New York. The Guilford Press. 1982.